Healthcare Provider Details

I. General information

NPI: 1811847932
Provider Name (Legal Business Name): THOMAS QUINTEN KLINGONSMITH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 HINEMLU ST.
GARAPAN SAIPAN MP
96950
US

IV. Provider business mailing address

1178 HINEMLU ST.
GARAPAN SAIPAN MP
96950
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8951
  • Fax:
Mailing address:
  • Phone: 670-234-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14307620-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAS-0138
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: